Nearly two and a half million Poles try for a child without success. Declining population growth – also due to civilization diseases which include infertility – is among the most serious problems of developing countries. However, this phenomenon concerns also developed countries, where women increasingly later decide to have children. We can talk about infertility when the pregnancy does not appear within a year – despite regular (2-3 times per week) unprotected sexual intercourse. Thanks to the achievements of modern medicine, this problem can be dealt with. It is worth learning more about the most recent methods of infertility diagnosis and treatment.

The first step in treating infertility – tests and a visit to a specialist

If for a longer time a couple tries for a child unsuccessfully, they should consult a specialist in the area of infertility treatment. Usually before the meeting, they should undergo a set of tests which will allow for a proper diagnosis. This concerns both partners, as the causes of problems with fertility lie often both with the woman and the man. Women should first check their AMH level. Usually at the same time, the levels of FSH, OH and estradiol as well as PRL, anti-TPO and testosterone are checked. Men should undergo basic semen analysis carried out with the use of computer (not manual) techniques.

At the first visit, the doctor will analyze the obtained results and gather data from the medical interview (among others, questions about general health condition, lifestyle, diseases in the family, miscarriages, menstrual cycle). The doctor will also perform standard gynecological examination and transvaginal ultrasound examination. On this basis, the fertility specialist will be able to recommend potential additional tests (like thyroid hormone test, various tests of steroid hormones, ultrasound hysterosalpingography (HSG), laparoscopy or hysteroscopy) and plan the most appropriate medical treatment.

Most common problems with getting pregnant

The most common cause of problems with getting pregnant are various hormonal disorders which in women result in ovulation disorders and in men – in abnormal semen parameters. Similarly often, the cause of infertility is related to past or untreated infections of reproductive organs. Long-lasting bacterial activity (and sometimes surgical interventions related to the infection, e.g. in the area of cervix) lead to lesions in reproductive tract which prevent fertilization. Furthermore, fertility may be affected by diseases such as polycystic ovary syndrome or endometriosis. Anomalies in the structures of reproductive tract and problems with immune system are also of significance. Sometimes the underlying causes of failures in achieving pregnancy are of psychological nature – if this is the case, psychologist’s or psychotherapist’s advice can help.

Treating the causes of infertility

Hormone therapy

The first sign of endocrine problems may be irregular menstruations, extended or shortened cycle or severe complaints associated with the pre-menstrual syndrome. If the doctor diagnoses hormone disorders, they have to be regulated with hormonal drugs. These medications will stimulate ovulation or promote the growth of an ovarian follicle, and the further observation of the cycle can enable the determination of the optimal time for fertilization.

Surgical treatment/procedures

The application of surgical procedures in the treatment of infertility is rather limited. The basic diagnostic and therapeutic procedure is hysteroscopy in case of suspected abnormalities in the structure or function of endometrium and suspected presence of uterine polyps or adhesions.

Laparoscopy is in practice useless in infertility diagnosis. The benefit of any additional information obtained during surgery does not outweigh the risk associated with a surgical intervention. Surgeries for ovarian cysts are among the most common causes of female infertility. During the unnecessary surgeries, a significant amount of ovarian tissue or the whole ovaries are resected, leading to the significant decrease in the female resources of eggs or even to the sterilization of women. This is particularly common during operations performed in patients with endometriosis who should not be subjected to such procedures until they cease to try for pregnancies.

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Published: 5 November 2015 Updated: 4 April 2017